Fungal meningitis kills three in Tennessee

Oct. 4, 2012

Written by

The Tennessean

UPDATE: 3:48 p.m.

Officials with the state’s Department of Health and the Centers for Disease Control and Prevention reported Thursday that a third Tennessean has died in the fungal meningitis outbreak that now touches six states: Indiana, Florida, Maryland, Virginia, North Carolina and Tennessee.

Vanderbilt University Medical Center reported two deaths. St. Thomas Hospital initially reported two deaths as well, but said Thursday afternoon that only one death was confirmed.
Nationwide, the outbreak continued to balloon Thursday. The CDC reported 35 cases of fungal meningitis in six states, with five deaths.
Twenty-five of those cases came from Tennessee, they said. More cases are imminent.
"We expect to see additional cases as this investigation unfolds," said Dr. Benjamin Park with the CDC.
All of the cases reported so far involved people who had received epidural steroid injections prepared by a Massachusetts compounding clinic between July 1 and Sept. 28. Those injections, which are typically administered for back pain, remain the chief suspect in the outbreak.
Ilisa Bernstein with the Food and Drug Administration said foreign fungal material had been found in a sealed vial from the facility. Investigators are continuing to analyze the material without ruling out other possible culprits.
Three separate lots of that injection have been voluntarily recalled and are the focus of the investigation. About 75 facilities in 23 states could have received the potentially contaminated steroid injections, national officials said.
Three clinics in Tennessee received the suspect steroid injections: the St. Thomas Outpatient Neurosurgery Center in Nashville, the Specialty Surgery Center in Crossville and the PCA Pain Care Center in Oak Ridge.
The Nashville and Crossville centers are the only ones in the state to report cases of fungal meningitis so far., according to Dr. John Dreyzehner, commissioner of the State Department of Health.
Fungal meningitis is incredibly rare, but Park said anti-fungal medicine, administered intravenously at the hospital, could be effective.
"We think that early anti-fungal treatment can improve the outlook for these patients," he said.
More than 1,000 people in Tennessee could have been exposed. Dreyzehner said most or all of them should have already been notified.
People should contact their physicians if they are concerned they were exposed.
Fungal meningitis cannot be transmitted from person to person, and is not connected with the rash of bacterial and viral meningitis that have recently broken out in Tennessee.
Symptoms, which could include worsening headaches, fevers, slurred speech or stiffness can take as much as a month to appear, officials said.
At a press conference in Boston , Dr. Madeleine Biondolillo, director of the Bureau of Healthcare Safety, for the Massachusetts Health Department, said that a total of 17,676 single dose vials were included in the three lots now being recalled. They were distributed by the company between July and late September.
“Hundreds have been returned,” she said, adding that she did not have an exact number.
She said that as a precautionary measure and to be “abundantly cautious,” the company was recalling all similar drugs it had issued. She said none of the suspect vials were distributed to Massachusetts hospitals.
Biondolillo said that New England Compounding was currently under investigation for a complaint registered in March about the potency of an eye drug the company had sold.
In 2006, she said the firm signed a consent decree stemming from complaints filed in 2002 and 2003. One of those complaints involved sterility issues, she said.
“Those complaints were registered through the FDA MedWatch program,” she said.
According to Massachusetts health officials, New England Compounding produced the drug used in the spinal procedures by taking a powder version of methylprednisone acetate and processing it so that it became soluble and could be injected into a patient.

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Reported earlier

A third person has died in Tennessee from a rare form of fungal meningitis, St. Thomas Hospital has confirmed.

The outbreak that has sickened at least 35 people in six states (including 25 in Tennessee), has now killed a total of at least five people.

A Massachusetts specialty pharmacy that already had a record of regulatory violations was linked Wednesday to the disease outbreak and voluntarily surrendered its license. Doctors and health officials in Tennessee had alerted federal officials that the company’s medicine might be the cause of the infections — an action that mobilized the nation’s health-care system to identify illnesses in other states and keep more people from getting sick.

Officials said today that 23 states have received the suspicious steroid injections from the Massachusetts compounding center.

Tennessee residents at risk are those who received epidural steroid injections as a pain treatment at Saint Thomas Outpatient Neurosurgery Center in Nashville, Specialty Surgery Center in Crossville and PCA Pain Care Center of Oak Ridge between July 1 and Sept. 28.

The state expanded the window of concern by 30 days back to July 1 on Tuesday.